In the first
article, Robbins and colleagues (4)
report evidence of the variable implementation
of Kendra's Law across
New York State. The use of AOT in
practice varies considerably across
counties and regions in New York
State. Notable regional differences
were found in the use of two distinct
models of AOT: AOT First and Enhanced
Voluntary Services First.
Data from interviews with key informants
documented regional differences
in how the AOT program
has been implemented and administered,
which raises questions about
the fairness of the application of the
statute.

Van Dorn and coauthors (6) report
on outcomes for AOT participants after
their court order ended. They
found that if the court order was kept
in place longer than six months, the
improved rates of medication possession
and decreased hospitalizations
were likely to persist after involuntary
outpatient commitment ended.
Although receipt of intensive case coordination
services (assertive community
treatment, intensive case
management, or both) in the post-
AOT period improved hospitalization
and medication possession outcomes,
individuals who had previous longterm
court orders (more than six
months) experienced these positive
outcomes even when they did not receive
ongoing intensive case coordination
services. Finally, these data
showed that former AOT recipients
were not deterred from voluntarily
seeking and receiving intensive services
once the court order was lifted.

The article by Swanson and colleagues
(7) explores the issue of
"queue jumping" raised by the AOT
program. In the context of scarce resources
for community-based services,
a question arises about whether an
involuntary treatment program, such
as that mandated by Kendra's Law, diverts
needed resources from individuals
who seek services voluntarily.
The authors report that initially the
AOT program may have crowded out
some individuals with serious mental
illness who did not meet criteria for
outpatient commitment. However,
after the first three years of the AOT
program, the increased service capacity funded during the start-up of the
program also expanded services for
those who did not qualify for cour tordered
treatment.

Involvement in the criminal justice
system has become an important outcome
measure for community treatment
programs that serve consumers
at high risk of incarceration. The
study by Gilbert and colleagues (8)
compared arrest rates of consumers
in the AOT program and consumers
receiving voluntary treatment. They
found a relative reduction in the odds
of being arrested among AOT consumers.
A reduction in arrests may
be an important benefit of AOT as
part of an effort to improve community-
based treatment outcomes and
reduce involvement in the criminal
justice system.

In a companion study that was not
included in the legislative report but
that appears in this issue of Psychiatric
Services, Busch and colleagues
(9) examined regional changes in
guideline-recommended medication
possession among individuals with
severe mental illness after implementation
of the AOT program, including
consumers who did not receive
either AOT or intensive outpatient
services. Although these authors
observed improvements in
medication possession in all three regions
and across all treatment groups
(those who ever received AOT, those
who never received AOT but received
enhanced services, and those
who never received either intervention),
they also found that trajectories
of improvement differed by region
and that the treatment groups did not
make similar gains across regions.

Taken as a whole these articles and
the full legislative report suggest that
New York State's AOT program can
improve a range of important outcomes
for consumers, apparently
without feared negative consequences,
such as dissatisfaction with
services received under court-ordered
treatment.

The information on Mental Illness Policy Org. is not legal advice or medical advice. Do not rely on it. Discuss with your lawyer or medical doctor. Mental Illness Policy Org was founded in February 2011 and in order to maintain independence does not accept any donations from companies in the health care industry or government. That makes us dependent on the generosity of people who care about these issues. If you can support our work, please send a donation to Mental Illness Policy Org., 50 East 129 St., Suite PH7, New York, NY 10035. Thank you. Contact office@mentalillnesspolicy.org Contact DJ Jaffe, founder http://mentalillnesspolicy.org.